Opening address by Dr Zsuzsanna Jakab, WHO Regional Director for Europe at the 67th session of the WHO Regional Committee for Europe

Address by Dr Zsuzsanna Jakab, WHO Regional Director for Europe

11 September 2017, Budapest, Hungary

May I extend my warmest welcome to Her Royal Highness the Crown Princess of Denmark, Honourable Ministers and delegations, ladies and gentlemen, and of course, Director-General, Dr Tedros.

Director-General, we share your dream that everyone can lead healthy and productive lives, regardless of who they are and where they live.

Now, in the era of the 2030 Agenda for Sustainable Development and universal health coverage, and with today’s knowledge, we can achieve this dream.

We must place health at the centre of development, focusing on the right to health, equity, fairness, universality and solidarity.

We must see health as the smartest thing to invest in, which yields high returns. This is what we have been doing in the European Region all these years.

Above all, we must secure strong political commitment to achieve these goals and, truly, we must “leave no one behind”.

For health is, indeed, a political choice. I welcome the presence of Prime Ministers and Deputy Prime Ministers who exemplify these efforts.

Ladies and gentlemen,

The SDGs call for concerted action to mobilize the necessary means and ensure implementation in a spirit of global solidarity. Our priorities are clear and we are moving forward with these joint commitments. We must focus on inequities, “leaving no one behind”, embedding gender and human rights into all policies. We must achieve universal health coverage. We must strengthen health systems with a focus on primary health care. We must work upstream, emphasizing health promotion and disease prevention throughout the life-course. We must address all determinants of health if we are to achieve health and well-being for all. And we must strengthen our emergency preparedness and response.

Ladies and gentlemen,

We can now precisely map Health 2020 key strategic objectives and policy priorities against SDG 3 and other SDG targets. As my talk proceeds, the visual presentation will demonstrate the congruity between the SDGs and Health 2020.

The good news is that we are succeeding. Our midterm review of Health 2020 implementation shows that we are on track towards a healthier Europe. Let me give you some examples.

Our latest data indicate that life expectancy across the European Region has now reached over 77 years. Healthy life expectancy has reached 68 across the Region. The mortality trend from major NCDs for those aged 30–69 years is declining for both sexes. Since 2003, almost all countries have shown an average annual decline of 2–3% in premature mortality. Infant mortality is the lowest ever, at 6.7 per thousand live births.

Yet, progress is uneven.

There are substantial inequalities within and between countries. For example, life expectancy across the Region ranges from 70 to 83 years, a difference of 13 years. Healthy life expectancy ranges from 60 to 73 years, a difference of over 13 years. Infant mortality has more than a tenfold difference. For children vaccinated against rubella, the difference is grave: from 42 to 99%. These are worrying disparities that need to be addressed with determined actions.

Ladies and gentlemen,

We know that health in the 2030 Agenda means far more than SDG 3. Health is an essential component and driver of other SDGs, reflecting the complexity, as well as the multidimensional and multisectoral nature of health and its determinants.

The key strategic objectives of Health 2020 point the way forward.

To achieve these, we need to transform the way we work. We need to build synergies across sectors, mobilize communities and individuals, and engage civil society by building consensus around the targets. We need to strive to make a reality of whole-of-government, whole-of-society and health-in-all-policy approaches.

The Conference on Promoting Intersectoral and Interagency Action, held in Paris in December last year, was an example of such critical engagement. I thank the Government of France for hosting the Conference, which brought together for the first time the health, social and education sectors from European countries.

In Paris, we agreed on concrete steps to give all children the best start in life and continuing life chances through family, education, health and social support. The Conference outcome provides the political impetus for our further intersectoral work. The platform created in Paris will remain permanent, as requested by Member States.

Partnerships are vital for effective implementation. The Regional Office leads the Regional United Nations agencies Issue-based Coalition on Health under the umbrella of the Regional Coordination Mechanism. The Paris platform and the Issue-based Coalition on Health are now linked and merged.

Subnational levels also play a crucial role in implementation. Some key platforms undertaking this role include:

the WHO European Healthy Cities Network Conference adoption of the Pecs Declaration.

We are committed to continuing our support of all these initiatives.

I would like to thank also the WHO Collaborating Centres, which are also an important source of support.

To achieve improvements in health and health equity, we must focus on health policies and health systems for the 21st century within the context of universal health coverage. This must be a core component of national development planning.

Our midterm review results show that Health 2020 has increasingly been incorporated into national health policies and this is generating action across countries. Almost all countries now have a national health policy aligned with Health 2020 that defines targets or indicators at the national or subnational levels. And most countries have a policy or strategy to address health inequalities.

What is needed is investment in health that many countries can afford. This is a political choice rather than an economic constraint.

Public health is a driver of equitable health improvement and we need a new and invigorated public health movement.

Available evidence shows that public health interventions are cost-saving and we can achieve high returns for health and sustainable development through investing in public health policies across the Region. Reducing health inequality by 1% per year would increase a country’s annual rate of GDP growth by 0.15%.

Health promotion and prevention works: a 10% reduction in cardiovascular diseases could save 20 billion euro per year in lower- and middle-income countries. In particular, we need to invest in social protection. Investing in early childhood development is estimated to produce a 17-fold return for each euro invested.The cost of no action is significant: direct and indirect costs of high disease burden in countries can consume up to 15–20% of GDP. Moreover, there is scope for increasing investment in public health.

To move the public health agenda forward, I commissioned a review to define the future role of public health and the importance of building institutional and human capacities. The information document is available at this Regional Committee.

Tomorrow we will review the roadmap for implementing the SDGs and we will also discuss a joint monitoring framework for Health 2020, NCDs and the SDGs.

Ladies and gentlemen,

Let me now turn to health systems.

Universal health coverage is a unifying concept, a platform for integrated delivery of health services and public health, and one of the most powerful social equalizers. Our definition is broad and covers “health services, as well as health promotion, disease prevention, treatment and rehabilitation, without financial hardship”. We, in Europe, are committed to universal health coverage and a lot has been done. The core message – “no one should become poor due to ill health” – is at the heart of the Tallinn Charter, as well as Health 2020.

Most countries in Europe provide health coverage for the whole population, but this alone is no guarantee of financial protection.Out-of-pocket payments for health are still high in many countries in the European Region. High-performing health systems provide strong financial protection to keep out-of-pocket payments to a minimum: that is, at or below 15% of total health expenditure.

Many countries need to increase the share of public financing for health and to implement stronger pro-poor policies.We are monitoring financial protection and producing estimates using a new approach for high- and middle-income countries in Europe.

A cornerstone to making progress is integrated people-centred health services. Evidence on effective policies is accumulating, but how to implement these complex agendas remains a challenge and informed guidance is lacking. We are now working with policy-makers on how to address concrete obstacles and enablers for a successful large-scale transformation.

We are preparing for two high-level meetings on health systems in 2018.

The meeting on health systems’ response to NCDs in Spain in April will provide a platform to review progress and inspire actions based on the country assessments we have conducted.

The meeting on “Health systems for prosperity and solidarity – Leaving no one behind” in Tallinn in June will celebrate the 10th anniversary of the Tallinn Charter.

These events will reconfirm the notion of value-based health systems and outline our future vision in view of the 2030 Agenda.

We are working to ensure that primary health care with a public health approach is at the core of health systems. WHO Centre for Primary Health Care in Almaty is fully operational and I thank the Government of Kazakhstan warmly for their support. In June 2017, I launched the Primary Health Care Advisory Group to support the development of the new primary health care vision towards the 40th anniversary of the Alma Ata Declaration in 2018. Please join this high-level global event in Almaty, I will be there, together with Dr Tedros.

Our Barcelona Office for Health Systems Strengthening continues to deliver health systems courses. I thank the Government of Spain for their continued support to the Barcelona Office. I am proud to report on two new WHO courses:

one on strengthening health systems for improved tuberculosis prevention, targeting representatives from ministries of health and finance and national health insurance funds of 11 countries; and

a course on health financing for universal health coverage, conducted for the first time in Russian as a summer school in Kyrgyzstan in July.

Universal health coverage is not sustainable without a well-motivated, appropriately skilled and effectively managed workforce. Health employment continues to increase and the health sector is a key economic sector and generator of decent jobs. We are leading on health workforce policy development and we will present the framework for action with a supporting toolkit on Wednesday.

Affordable access to effective, high-quality medicines is another major component of universal health coverage and is of great concern to many Member States. Pharmaceuticals are the main driver of out-of-pocket spending, especially in poorer countries, and people increasingly cannot afford essential and new medicines. WHO is working on a new social pact with the industry to ensure fair pricing that allows access to affordable safe medicines while providing incentives to the industry for innovation. We will present a proposal on strengthening Member States’ collaboration on improving access to medicines on Wednesday.

In Europe, we believe that high-quality health information and evidence is the backbone of solid public health policies. Since I reported on this extensively in previous years, today I will focus on some key areas. I am happy to report that dissemination of health information has further expanded and several new publications are available. One example is the Health Evidence Network reports that serve as a core source of evidence, proposing policy options. I am proud to announce that the HEN report on the cultural contexts of health is receiving a British Medical Association Highly Commended Award today.

I would like to emphasize the importance of eHealth, which will continue to develop and challenge our understanding of the role of public health. A landmark achievement was made in Malta in May at the annual eHealth Week conference, hosted by the European Commission and the Maltese Ministry of Health. Please join us for the technical briefing on this topic on Thursday, when we will explore the strategic role of big data in health.

Ladies and gentlemen,

Controlling and reducing the burden of NCDs is at the heart of SDGs and Health 2020.

As mentioned before, the good news is that there has been a significant decline in deaths due to NCDs and a considerable reduction in premature mortality, particularly for cardiovascular diseases. This progress has created the hope that the Region might exceed the bold SDG target of reducing such deaths. I look forward to representing this success on your behalf at the WHO Global Conference on NCDs in Uruguay in October.

The countries in the European Region have improved their governance: national plans and targets are being defined and information systems improved; and management of NCD conditions is being strengthened. The WHO Office for Noncommunicable Diseases in Moscow has increased our capacity to support Member States. I express my warm thanks to the Government of the Russian Federation for their generous support.

On NCDs, however, there remains a paradoxical situation in Europe.

Health systems are still not delivering the prevention and care that they could. tobacco and alcohol are too affordable and the European population continues to consume too much sugar, fat, salt and trans fats, not to mention the social and environmental factors. There are still too many men of working age who are dying from a preventable and untimely death. Now is the time to take bold actions to alter these trends and beat the NCDs.

We can further improve the management of NCD conditions, such as cardiovascular diseases, hypertension, diabetes and cancer. We can achieve further reductions in the disease burden by fully implementing cost-effective actions.

Ladies and gentlemen,

Our aim is to eliminate major vaccine-preventable diseases in the European Region and we are making good progress towards measles and rubella elimination. Since the last Regional Committee, another five countries have interrupted endemic measles and rubella transmission, bringing the total to 42 countries. However, recent measles outbreaks in some countries, with deaths and complications are an unacceptable setback, exposing shortcomings in immunization service delivery.

The European Vaccine Action Plan acknowledges the right of every child and adult to immunization. We have come a long way; but we have not come far enough.

Complex barriers stand in our way, such as vaccine supply shortages, lack of sustainable financing and political commitment, and public complacency about diseases that are no longer common. Ensuring equitable access to immunization remains a priority. I personally have been very active to counter this trend, advocating for political commitment and public awareness to make informed and responsible choices.

European Immunization Week remains our flagship event and we are privileged for the continued support of our Patron, Her Royal Highness the Crown Princess of Denmark.

Following the milestone of interrupting indigenous malaria transmission in the Region last year, we now focus on preventing its reintroduction. Constant vigilance, strong surveillance and intersectoral and cross-border collaboration are essential to maintain malaria-free status and also to address other vector-borne diseases. As agreed at World Health Assembly, we will consult with you on the development of a regional vector control plan, building on the Regional Framework for vector-borne diseases on Thursday.

Thanks to your intensive efforts, as well as that of our partners, particularly the Global Fund, our Region has had the fastest decline in tuberculosis incidence and mortality rates among all WHO regions during the past five years. Yet tuberculosis, and particularly its drug-resistant forms, remains a major public health concern with over 300 000 cases occurring this year.

Moreover, tuberculosis and HIV co-infection is increasing by 6.2% every year.

A major focus now is to address health systems-related barriers, shifting toward integrated models of care, with sustainable financing.

Let me remind you that the Russian Federation will host the first ever Global Ministerial Conference on Tuberculosis in November this year to inform the High-Level Meeting of the United Nations General Assembly in 2018.Both the Director-General and I will attend and I call upon all of you to join us at this important event.

With HIV, we need to act immediately as the epidemic in the eastern part of the Region is growing at an alarming rate. New HIV diagnoses increased by 75% in the European Region as a whole and have more than doubled in eastern Europe and central Asia since 2006, mostly driven by two countries.

Last year you endorsed the new action plan and committed to providing an accelerated and innovative response to HIV. I call once more for urgent action and commitment by the affected countries. We must implement the Plan fully, adopting evidence-based policies to reverse this epidemic.

Let me remind you of the 22nd International AIDS Conference, an excellent platform to share information and evidence on HIV, which will be hosted by the Netherlands in July 2018.

The Regional plan for viral hepatitis triggered increasing commitment and improved access to viral hepatitis services, including hepatitis C treatment, across the Region. We need to build on this positive momentum and take comprehensive actions for prevention, diagnosis and treatment, if we are to eliminate viral hepatitis.

As the global momentum to address antimicrobial resistance continues, I am pleased that more countries in our Region are embarking on multisectoral national action plans. We are increasingly engaging with UN agencies and development institutions to address this global threat. I would like to thank the Government of Germany for putting health at the heart of the G20 agenda and committing to AMR, together with other global health challenges, in the Berlin Declaration this year.

We will jointly work on implementing the WHO European action plan, together with the European Union’s newly launched One Health Action Plan against Antimicrobial Resistance. The world will mark the third World Antibiotic Awareness Week in November. Last year, 47 European countries joined the campaign and it is my sincere hope that all 53 countries will mark the week this year. Here, again I would like to acknowledge the valuable support provided by our Patron.

Ladies and gentlemen,

Another priority of the Regional Office is preparedness and response to health emergencies.

I am delighted to report that the WHO Health Emergencies Programme is now fully functional. New standard operating procedures are in place and the updated Emergency Response Framework is already being implemented, as evidenced by the rapid and efficient response to all recent health emergencies.

In the European Region, our priority is to strengthen emergency preparedness and IHR capacities, linking with health systems and public health functions. Guided by the IHR and using all-hazard, multisectoral and whole-of-society approaches, targeted interventions are being implemented in priority countries. The focus is on vulnerable communities, creating stronger linkages between humanitarian response and development, focusing on equity.

Scaling up IHR core capacities and broadening partnerships engaging all relevant national and international players and civil society are at the centre of our health security work. It is critical that countries commit to full and comprehensive implementation. The establishment of the WHO Office for Emergency Preparedness in Istanbul will further strengthen our capacity, and I thank the Government of Turkey for their commitment.

With improved coordination and collective action and, together with partners, we are leading the response to two protracted emergencies in the European Region.

In Ukraine WHO has been leading the international humanitarian health response through the Country Office in Kyiv and three field offices. Together with partners, WHO has delivered medical supplies and established mobile primary health care units, providing services along the contact line, mostly to internally displaced persons. Multidisciplinary teams have assisted in the provision of mental health and psychosocial support and sentinel sites have started regular reporting on infectious diseases.

Turkey, the country with the highest number of refugees in the world, is hosting more than 3 million Syrian refugees. We are leading the health sector, together with the Turkish Ministry of Health, to improve refugees’ access to essential health services. Important new Turkish legislation allows Syrian health professionals to provide health care to refugees, after completing required training. So far, we have trained almost 2000 Syrian doctors, nurses and translators to provide primary and secondary care. This new model in Turkey has proven effective for ensuring universal access of refugees to health, setting a good example for other countries in similar situations.

In line with the Whole-of-Syria approach, the WHO office in Ankara and field office in Gaziantep continue to provide cross-border humanitarian assistance to northern Syria, in an extremely challenging environment. WHO, along with health partners, has delivered emergency kits, medicines and supplies; provided primary health care and mental health and psychosocial support; and delivered vaccinations for children.

Of concern is the detection of 39 cases of circulating vaccine-derived polio type 2 in northern Syria. Thanks to our effective partnership with the Regional Office for the Eastern Mediterranean, 84% of vulnerable children were reached to contain the outbreak, despite the ongoing conflict.

Ladies and gentlemen,

We must move away from the narrowly confined health care, to a wider multisectoral framework, dealing with all determinants of health in a comprehensive way, with full political commitment. Health is affected by a variety of determinants across the life-course, which are interlinked and influenced by policies, environments and norms created by society. Determinants like health inequalities present a serious threat to a country’s economic and social development and political stability. Education, employment and working conditions have powerful effects on health and equity.

Progress in health and well-being is not possible without addressing all the determinants of health: political, economic, environmental, social, behavioural, as well as cultural and commercial. The Regional Office has been a major advocate and gatherer of evidence on the determinants of health, as well as a facilitator of action in countries.

With regard to behaviour, opportunities for healthy choices are socially determined, as they are influenced by social and economic norms and policies. Let me now present some examples of behavioural determinants.

On tobacco control, we are making progress. One example is the global movement for plain packaging of tobacco products. I want to thank the seven European Member States leading this global effort, who have passed legislation on plain packaging. Unfortunately, despite decrease in tobacco use among adults in some countries, the decline in smoking at the Regional level is still slow.

Thanks to the Government of Turkmenistan for supporting our tobacco control work. We will finalize the results in time for the Second Ministerial Conference on NCDs next year. Let me repeat my plea, calling on all Member States to ratify the Protocol to Eliminate Illicit Trade in Tobacco Products. We need 10 more ratifications for the Protocol to enter into force, and you heard this also from the Director-General this morning.

On alcohol, the Regional decline in consumption is simply too slow as we are aiming for a 10% decline by 2025 to achieve the 2030 global target. Many countries are adopting the best buys for alcohol and taking legislative measures to control price, availability and marketing – but more needs to be done.

Rising obesity and unhealthy diets are of great concern, especially among children and adolescents which alone risks slowing or reversing the gains we have made in premature mortality. We must look for new solutions; for faster and more effective preventive actions.

Ladies and gentlemen,

Health inequalities have their roots in the social determinants of health. Health inequalities affect everyone, not just the poor. The consequences for a country are poor economic performance, long-term social injustice and, ultimately, political instability.

The European Region has been the main driver of action on social determinants and on developing and sustaining intersectoral policy approaches. We need concerted and integrated policy and governance responses across governments and society with a special focus on social protection. This should be a priority now for all governments.

Our Office for Investment for Health and Development in Venice has been a major contributor for collating evidence and advocating for action and policy responses to the social determinants of health. Its new premises have now been inaugurated and I thank the Government of Italy and the Veneto Region for their continued support.

Environmental risk factors are estimated to cause 1.4 million deaths per year in our Region – deaths that could be prevented.

The political commitment to address this unacceptable burden was renewed at the Sixth Ministerial Conference on Environment and Health in Ostrava in June. The Conference was co-organized with the United Nations Economic Commission for Europe (UNECE) and the United Nations Environment Programme (UNEP), with the active involvement of cities and regions. I sincerely thank the Government of the Czech Republic and the regional authorities for their hospitality. Through the Ostrava Declaration, Member States are committed to achieving relevant SDG targets and enhancing national implementation by the end of 2018.

I thank the Government of Germany for its continuous support to the European Centre for Environment and Health in Bonn. The Centre will continue to provide comprehensive technical support for environment and health, focusing on the seven priority areas of the Ostrava Declaration.

Last year, ladies and gentlemen, we discussed the outcome of Belarus Ministerial Conference on the Life Course Approach. We agreed on the need to increase the effectiveness of interventions throughout life to achieve our goal of equitable health and well-being for all. This year, therefore, I will focus only on a few selected issues.

Let me emphasize that the health of women, children and adolescents continues to be a priority, as does the implementation of the Action Plan for Sexual and Reproductive Health. We are supporting countries in developing their national sexual and reproductive health policies. We have started working on the development of sexuality education and health promotion, as you requested more guidance in this area.

If we are indeed to “leave no one behind”, we must redouble our efforts for people with mental disorders and psychosocial disabilities. Improving the standards and quality of care in long-stay institutions, using a human rights approach will be discussed during tomorrow’s ministerial lunch, together with the strategies for prevention and treatment of depression, which was also the theme of this year’s World Health Day.

Another group not to be left behind is migrants and refugees.

The European Region is leading in this area by implementing the European action plan. We have contributed substantially to the development of the global framework of priorities and guiding principles to promote the health of refugees and migrants at the World Health Assembly. Now, we should join our efforts to ensure that health is fully recognized in the global compacts relating to refuges and safe and orderly and regular migration, currently under development by the United Nations.

In November 2016, we launched the European Knowledge Hub on Health and Migration, thanks to the support of the Government of Italy and the Regional Health Council of Sicily. We conducted the first Summer School on Refugee and Migrant Health at the Hub this year.

Ladies and gentlemen,

Everything we do, we do with and for countries, putting their health needs at the core. I would like to thank all Member States for their commitment and excellent collaboration towards better health and well-being of the European population.

Country office staff are at the forefront in implementing our commitments. While maintaining a workforce of excellence at the Regional Office, we have substantially strengthened our country office capacity. The number of international representatives heading country offices has tripled since 2014. I would like to use this opportunity to thank all my staff for their dedicated and exemplary work.

We have prepared a document for this Regional Committee which explains the WHO country presence in the Region and highlights a few examples of our extensive country work. The technical briefing on Tuesday will demonstrate how the Regional Office has continued to strengthen its work at the country level, benefitting all 53 Member States.

As in previous years, ministerial visits to the Regional Office have continued to provide an excellent platform for discussing regional strategic objectives and national priorities and for strengthening collaboration. We have been honoured to welcome 15 ministerial and high-level visits to the Regional Office. I have had the honour of visiting some 28 countries and I am extremely grateful for the high-level political commitment I have been afforded during these visits. I have been privileged to meet not only with Ministers of Health but also with Presidents and Prime Ministers, advocating for health at the highest levels of government, moving the health agenda forward.

As you have seen throughout my speech, everything we do, we do together with partners, and I am pleased to see so many of you here with us today. We will continue to build on existing partnerships. With the proposed partnership strategy, we intend to expand our engagement with partners at all levels, including with civil society and the private sector. A process for the accreditation of non-State actors to attend Regional Committee sessions will be submitted for your consideration later this week.

Ladies and gentlemen,

During this biennium, we continued to sustain the strong accountability framework for better results and to internalize risk management across operational processes. There is zero tolerance for risks related to compliance with the rules and regulations.

We will present the Regional plan for implementation of the programme budget 2018–19, the result of our joint bottom-up planning on the regional contribution to global outputs. It forms the contract between us to ensure accountability.

WHO reform will continue through a bottom-up approach, involving staff. Resource mobilization will aim for a stronger partnership with a particular focus at country level, and clear communication on results achieved, to ensure accountability.

Later today, we will discuss the draft Thirteenth General Programme of Work as the policy framework aligned with the SDGs, focusing on health policies and health systems for the 21st century within the context of universal health coverage.

We now have a wealth of knowledge on health and well-being, and evidence on the determinants of health and their interplay. We have the prospect, if we are determined, to extend the length and quality of human lives. We must recommit to these goals, applying the principles of equity and solidarity. The SDGs and Health 2020 lead the way. We need commitment from politicians, policy makers, professionals and from the European people.

The issues before us present both an opportunity and a challenge: WHO is committed to achieving better health for Europe: more equitable and sustainable, leaving no-one behind.